“The More Things Change, the More They Stay the Same.”
When Ascendient was launched in the summer of 1994, Congress was debating the Clintons’ “Managed Competition” plan to reform the US healthcare system. It faced defeat a few months later. In the decades since, we applauded the passage of the Affordable Care Act in 2010, imperfect though it may be, as a first step in fixing the country’s healthcare system. Although the healthcare reform debate has quieted since the 2016 mid-terms, an undercurrent remains.
In 1994, hospitals across the United States were taking care of about 30,000,000 inpatients annually for about six days each on average. While the rate of inpatient hospitalization has declined in the last 25 years, population growth means that hospitals are taking care of more people today. On daily basis, just under a half million people were in a hospital bed in 1994. Today, more than 600,000 people are hospital inpatients each day, each for about six days on average.
In 1994, surgeons performed approximately 28 million ambulatory surgery procedures, with 85 percent of those visits occurring in hospitals. Today, the number of ambulatory surgery procedures has more than doubled and only 55 percent occur in hospitals. In 1994, there were over 2,000 Medicare-certified ambulatory surgery centers; today, there are more than 5,500 centers as the number of procedures approved for, and performed in, these settings has exponentially grown over the last 25 years.
The More Things Must Change
We strongly believe that we are, and must be, embarking upon a transformational journey in healthcare. Providers must seek to change how we are paid for care, as too often we are paid well for care in the most expensive settings and paid far too little in those primary care settings that have the greatest impact on the day-to-day health of those we serve. Providers must seek to change how we deliver care, as too often we deliver too much or too little care, in the wrong place, and at the wrong time. We must strive to deliver the exact right care, in the right place, at the right time and by the right provider. We must reconfigure our systems of care so that community-based services are at the heart of who we are. We must find new avenues to improve health for everyone. We must explore fundamental shifts in the cost of the care we provide. And, we must seek to do all of this with responsible transparency.
The More Things Must Stay the Same
Despite facing the most significant change since the modern era of healthcare commenced more than a half century ago, we believe that so much of what providers do must be preserved. We must continue to ensure that all who seek care, find care. We must continue to strive for unparalleled quality in our care and service. We must continue to pursue ever more efficacious forms of technology and treatment. We must continue to be a partner with, and invest in, our communities. We must continue to serve with purpose and passion. We must continue to hold the hands of our patients in their most joyous moments and in their most trying ones. We must observe with awe, birth, and with dignity, death. We must continue to provide hope, healing, and health.
To our colleagues, friends and clients, thank you so much for the privilege to serve you over the last 25 years. We look forward to walking alongside you on the transformation journey ahead.
 Jean-Baptiste Alphonse Karr